Health inspection·December 14, 2023

F 0727 Level of Harm - Potential for minimal harm Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. Based on interviews and record reviews, the facility failed to utilize the services of an RN for 8 consecutive hours 7 days a week for 49 days out of 438 days reviewed. Residents Affected - Many The facility failed to have an RN for 8 consecutive hours 7 days a week for 49 days out of 438 days reviewed from September 30, 2022, through December 11, 2023. These failures could place all residents at risk for their clinical needs not being met. Findings included: Review of daily staffing data revealed the facility did not provide the services of an RN on the following dates: October 16, 2022, October 29, 2022 October 30, 2022, December 25, 2022, December 31, 2022, January 28, 2023, March 05, 2023, March 15, 2023, April 08, 2023, April 15, 2023, May 01, 2023, May 28, 2023, June 04, 2023, June 17, 2023, June 25, 2023, July 01, 2023, July 02, 2023, July 16, 2023, July 19, 2023, July 30, 2023, August 01, 2023, August 14, 2023, August 16, 2023, August 17, 2023, August 18, 2023, and October 01, 2023. Review of daily staffing data revealed the facility did not provide the services of an RN for 8 consecutive hours on the following dates: October 10, 2022 an RN was onsite for 7.94 hours, November 09, 2022 an RN was onsite for 7.12 hours, November 12, 2022 an RN was onsite for 1.02 hours, November 13, 2022 an RN was onsite for 7.52 hours, December 24, 2022 an RN was onsite for 7.82 hours, January 01, 2023 an RN was onsite for 3 hours, January 10, 2023 an RN was onsite for 5.6 hours, January 15, 2023 an RN was onsite for 7.59 hours, January 21, 2023 an RN was onsite for 7.43 hours, January 22, 2023 an RN was onsite for 4.03 hours, February 20, 2023 an RN was onsite for 7.43 hours, February 26, 2023 an RN was onsite for 2.88 hours, March 12, 2023 an RN was onsite for 7.83 hours, March 18, 2023 an RN was onsite for 2.04 hours, April 11, 2023 an RN was onsite for 7.95 hours, April 28, 2023 an RN was onsite for 7.85 hours, May 07, 2023 an RN was onsite for 6.82 hours, May 23, 2023 an RN was onsite for 5.57 hours, June 24, 2023 an RN was onsite for 2.08 hours, July 15, 2023 an RN was onsite for 2.40 hours, July 17, 2023 an RN was onsite for 5.10 hours, August 15, 2023 an RN was onsite for 5.80 hours, October 21, 2023 an RN was onsite for 1.90 hours. Review of the Payroll Based Journal report dated 12/06/2023 revealed No RN hours triggered as an area of concern. The following dates were identified: May 20, 2023, June 03, 2023, June 7, 2023, June 16, 2023, June 18, 2023, and June 19, 2023. The facility provided records indicating RN hours as follows: May 20, 2023, 8.17 hours, June 03, 2023, 11.29 hours, June 7, 2023, 20.32 hours, June 16, 2023, 11.15 hours, June 18, 2023, 11.25 hours, and June 19, 2023, 11.48 hours. Page 1 of 5 676321 676321 12/14/2023 Windsor Nursing and Rehabilitation Center of Corpu 3030 Fig St Corpus Christi, TX 78404

F 0727 Level of Harm - Potential for minimal harm Residents Affected - Many During an interview on 12/14/23 at 1:30 PM, the administrator stated his expectation of Registered Nurse coverage was at least 8 hours a day, 7 days a week. He stated staying in compliance with regulations was important for the facility and the residents. He stated the importance was because of the expertise an RN had to handle critical issues that may occur. The administrator explained the discrepancy on the payroll-based journal report was due to agency nurse coverage that was not captured in the system for the report. During an interview on 12/14/23 at 1:45 PM, the DON stated her expectation of Registered Nurse coverage was for an RN to be on-site the required number of hours. She stated she was a stickler for making sure to meet the requirement. The DON explained the purpose of complying with the requirement was due to the advanced training and knowledge an RN had to deal with complex issues such as in an emergency. The DON stated the quality of care was improved when an RN was onsite for at least 8 hours every day of the week. During an interview on 12/14/23 at 2:06 PM, the ADON stated having an RN onsite everyday was necessary due to an RN's increased scope of practice. She stated RNs were equipped to perform more advanced tasks in resident care. During an interview on 12/14/23 at 2:13 PM, RN A stated an RN was trained to perform an in-depth assessment. She stated an RN's advanced skills could make a difference in being able to care for a resident's needs in the facility versus transferring a resident to an acute care facility. RN A explained the facility protocol if an RN did not show up for a shift, staff had been instructed to call the DON. She stated all nursing staff aware an RN must be in the building for 8 hours every day. Review of the facility policy titled Nursing Services - Registered Nurse (RN) dated October 2022 revealed under the Policy Explanation and Compliance Guidelines section, item 1. The facility will utilize the services of a Registered Nurse for at least 8 consecutive hours per day, 7 days per week. 676321 Page 2 of 5 676321 12/14/2023 Windsor Nursing and Rehabilitation Center of Corpu 3030 Fig St Corpus Christi, TX 78404

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, interviews, and record reviews, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in 1 of 1 kitchen reviewed for kitchen sanitation The facility failed to ensure kitchen staff used proper hand washing and sanitation procedures when handling and serving food. These failures placed residents who received food from the kitchen at risk for food borne illness. Findings include: During an observation on 12/12/2023 beginning at 11:31 a.m., observed the Morning [NAME] as she picked up a piece of round, raw frozen sausage out of a small box with no gloves on, only using her bare hand. Observed the Morning [NAME] as she took the raw, round, frozen sausage and wrapped a napkin around the patty and placed the sausage in the microwave. Observed the Morning [NAME] as she immediately poured flat noodles out of plastic bag into a pan of water on the stove and then poured the extra, uncooked noodles into a zip lock bag and closed the seal on the bag. Observed the Morning [NAME] as she removed a plate from the plate warmer and placed the plate on the counter, then she removed two slices of bread from a bag and placed both in the toaster with no gloves on, only using her bare hand. Observed the Morning [NAME] as she went to the stove and removed a small frying pan and sprayed cooking spray on the inside of the pan without washing her hands. Observed the Morning [NAME] as she cracked an egg into the pan not using gloves. Observed the Morning [NAME] as she walked across the kitchen to the 33-gallon rubber trash can and lifted the lid with her bare hand and discarded the eggs shells. Observed the Kitchen [NAME] as she walked back to the stove and picked up a spoon and stirred the noodles, then picked up a spatula to stir the egg. Observed the Morning [NAME] as she removed the sausage patty from the microwave by holding the item with her bare hand and the napkin and placed the sausage on the plate. Observed during the time frame that the Morning [NAME] did not wear gloves or wash her hands. During an observation on 12/12/2023 at 11:40 a.m., observed a dark gray 33-gallon plastic trash can that was placed next to the wall approximately eight (8) feet from the stove. Observed the trashcan was over-filled with trash items with the lid sitting above the rim of trashcan. Observed the lid of the trashcan was stained with yellow and orange substances and had black marks and smudges on the top and rim of the lid. During an observation on 12/12/2023 at 11:42 a.m., observed the Morning [NAME] as she picked up a plate and spooned beef tips onto the plate and then sat the plate down on the counter and walked over to the 33-gallon rubber trash can and lifted the lid and placed a piece of paper into the rubber trash can. Observed the Morning [NAME] as she walked back to the stove and resumed spooning beef tips onto a plate. The Morning [NAME] did not wash her hands after touching the rubber trash can. During an interview on 12/12/23 at 11:45 a.m., the Dietary Manager said the kitchen staff were required to wear gloves when touching food. During an observation on 12/12/2023 at 11:49 a.m., observed the Morning [NAME] as she picked up multiple slices of bread and tore the bread into pieces with her bare hands and placed the bread into 676321 Page 3 of 5 676321 12/14/2023 Windsor Nursing and Rehabilitation Center of Corpu 3030 Fig St Corpus Christi, TX 78404

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some the puree machine. The Morning [NAME] had not washed her hands. Observed the Morning [NAME] as she walked over to the 33-gallon rubber trashcan and lifted the lid and threw away the plastic bag and walked back to the counter and pureed the bread by placing the lid the on machine and turning the machine on. At no time was the Morning [NAME] observed wearing gloves or washing her hands. During an observation on 12/12/2023 at 12:04 p.m., observed the Morning [NAME] as she put food on a plate and handed plate to the Dietary Aide, with her thumb on the inside of the plate touching the butter noodles. Observed the Morning [NAME] as she took her hand and wiped the food off her thumb onto her pants. Observed the Morning [NAME] was not wearing gloves. During an interview on 12/12/23 at 1:35 p.m., the Dietary Aide said she had been at the facility for 11 years. The Dietary Aide said when she touched raw or cooked food with her hands, she was required to wear gloves and had been in-serviced on the requirement. The Dietary Aide said the trash can with the lid that had to be lifted with her hand to place trash in was unacceptable and a source of cross-contamination. The Dietary Aide said she had been trained on employee sanitation and food storage. During an interview on 12/12/2023 at 1:48 p.m., the Morning [NAME] said she had been at the facility for nine (9) years. The Morning [NAME] said she knew that she was not supposed to touch food items with her bare hands, and she was required to wear gloves when she handled food. The Morning [NAME] said she aware that during lunch preparation on that day, she touched a frozen sausage patty, the bread she had put in the toaster, and bread she had crumbled to puree without wearing gloves and without washing her hands. The Morning [NAME] said she was in a hurry and forgot to put gloves on. The Morning [NAME] said she was aware that she needed to wash her hands after she changed her gloves, when she touched the trash can including the lid, or touch her face or hair. The Morning [NAME] said that when she touched the trash can lid with her bare hand and then touched food without washing her hands or wearing gloves was cross contamination. The Morning [NAME] said cross contamination could make the residents who were served out of the kitchen sick. The Morning [NAME] said she was trained on employee sanitation, food storage, and food preparation and handling. During an interview on 12/14/2023 at 1:51 p.m., the Dietary Manager said she had been at the facility for 11 years. The Dietary Manager said the Morning [NAME] touching food with her bare hands instead of wearing gloves was unacceptable and she said the Morning [NAME] knew better. The Dietary Manager said what had occurred during observations on 12/12/2023 did not meet her expectations. The Dietary Manager said the Morning [NAME] touching the trash can lid and not washing her hands was unacceptable. The Dietary Manager said the action would cause cross contamination and could contaminate the food and make the residents sick. The Dietary Manager said kitchen staff were required to wear gloves when they touched food. The Dietary Manager said kitchen staff were required to wash their hands when they touched the trash cans, touched their face, went to the bathroom, or changed gloves. The Dietary Manager said the Morning [NAME] putting her thumb in the noodles when she served the plate and then handing the plate to the Dietary Aide did not meet her expectations. Record review of the facility's policy, Food Preparation and Handling, dated 06/01/2019, revealed to ensure that all food served by the facility was of good quality and safe for consumption, all food would be prepared and handled according to the state and US Food Codes and HACCP guidelines. Procedure included preparing food with the least manual contact possible. Do not allow bare hands to touch raw food directly. Record review of the facility's policy, Employee Sanitation, dated 10/01/2018, revealed employees 676321 Page 4 of 5 676321 12/14/2023 Windsor Nursing and Rehabilitation Center of Corpu 3030 Fig St Corpus Christi, TX 78404

F 0812 Level of Harm - Minimal harm or potential for actual harm must wash their hands and exposed portions of their arms at designated hand washing facilities immediately before engaging in food preparation including working with exposed food, clean equipment and utensils, and unwrapped single-service and single-use articles; during food preparation, as often as necessary to remove soi and contamination and prevent cross contamination when changing tasks. Residents Affected - Some 676321 Page 5 of 5